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European Journal of Pain Tables of Contents and Abstracts Online Issue Contents Chronic non-malignant pain patients and health economic consequences Annemarie Bondegaard Thomsen, Jan Sørensen, Per Sjøgren, Jørgen Eriksen p 341-352, Volume 6, Number 5, October 2002 Abstract A prospective cohort study on chronic non-malignant pain patients was performed to describe health consequences and changes in use of health care resources and social transfers following multidisciplinary pain treatment. Patients, referred to a Danish Multidisciplinary Pain Center (MPC), were evaluated during four periods: six months prior to referral, waiting list period, intervention, nine months follow-up. Outcome measures: pain intensity (VAS), The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), The Psychological General WellBeing Index (PGWB), The Hospital Anxiety and Depression Scale (HAD). Use of health care resources and social transfers were retrieved from public registers. Statistically significant improvements were obtained in pain intensity, SF-36 bodily pain, PGWB index and subscores vitality, and general health at discharge and follow-up. Intervention costs amounted to EUR 1102 (SD 721). Health care costs were not significantly reduced, but significant reductions in social transfers were seen. August 2002 • Volume 16 • Number 4 Original Articles The use of a bronchial blocker compared with a double-lumen tube for single-lung ventilation during minimally invasive direct coronary artery bypass surgery Jörg Ender, MD [MEDLINE LOOKUP] Andreas M. Bury, MD [MEDLINE LOOKUP] J. Raumanns, MD [MEDLINE LOOKUP] S. Schlünken, MD [MEDLINE LOOKUP] H. Kiefer, MD [MEDLINE LOOKUP] W. Bellinghausen, MD [MEDLINE LOOKUP] A. Petry, MD [MEDLINE LOOKUP] Abstract TOP Objective: To investigate whether a bronchial blocker (BB) placed through a routinely used single-lumen tube (SLT) to achieve 1-lung ventilation is appropriate in patients undergoing a minimally invasive direct coronary artery bypass (MIDCAB) operation. Design: Clinical trial. Setting: University hospital. Participants: Patients scheduled for elective MIDCAB operation (n = 159). Interventions: Group A was treated with a left-sided double-lumen tube (DLT) and served as the control group. Group B was intubated with a routinely used SLT in combination with a BB. Measurements and Main Results: The following data were collected: (1) time required for placement of each tube, (2) ventilation pressures, (3) lung compliance, (4) dislocations of the DLT or BB, (5) effectiveness of lung collapse, and (6) PaO2 and fraction of inspired oxygen. In 4 patients (4%) of group B, the BB could not be placed within an acceptable time so that 155 patients (50 patients in group A, 105 patients in group B) were statistically analyzed. Statistically significant differences during 1-lung ventilation were found for peak and mean inspiratory pressure (p < 0.001 and p < 0.05), dynamic and static lung compliance (p < 0.05), and dynamic lung compliance change (p < 0.01). No statistical significance was found for intubation time (p > 0.05) and PaO2 and fraction of inspired oxygen (p > 0.05). Lung collapse was insufficient in 1 patient of group A (2%) and in 2 patients of group B (2%). Conclusion: To achieve 1-lung ventilation during a MIDCAB procedure, the use of a BB combined with an SLT is an appropriate technique as an alternative to the commonly used DLT. Copyright 2002, Elsevier Science (USA). All rights reserved. Publishing and Reprint Information TOP From the Department of Anesthesia and Intensive Care II, Heart-center, University of Leipzig, Leipzig, Germany. Address reprint requests to Jörg Ender, MD, Klinik für Anästhesie und Intensivmedizin, Park-Krankenhaus Leipzig-Südost, Strümpellstrasse 41, 04289 Leipzig, Germany. E-mail: [email protected] Copyright 2002, Elsevier Science (USA). All rights reserved. Original Articles Coronary revascularization: A procedure in transition from on- pump to off-pump? The role of glucose-insulin-potassium revisited in a randomized, placebo-controlled study Andrew Smith, FRCA [MEDLINE LOOKUP] Amanda Grattan, BapplSc [MEDLINE LOOKUP] Mark Harper, FRCA [MEDLINE LOOKUP] David Royston, FRCA [MEDLINE LOOKUP] Bernhard J.C.J. Riedel, FCA, MMed [MEDLINE LOOKUP] Abstract TOP Objective: To investigate an optimized glucose-insulin-potassium (GIK) solution regimen as an alternate myocardial protective strategy in off-pump coronary artery bypass graft (OP-CAB) surgery and as a supplement to conventional coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass (CPB). Design: Prospective, randomized, placebo-controlled. Setting: Single institution, cardiothoracic specialty hospital. Participants: Forty-four patients scheduled for elective multivessel coronary artery surgery using either conventional CPB (n = 22) or OP-CAB techniques (n = 22). Interventions: Preischemic, ischemic, and postischemic administration of GIK solution was carried out, optimally dosed to ensure nonesterified fatty acid (NEFA) suppression, and supplemented with magnesium, a glycolytic enzymatic cofactor. Measurements and Main Results: GIK solution therapy reduced plasma NEFA levels (p < 0.001) in OP-CAB surgery and CPB groups but failed to affect the incidence of non–Q wave perioperative myocardial infarction, incidence of postoperative atrial fibrillation, incidence of postoperative infection, reduction in creatinine clearance, or duration of postoperative intensive care unit or hospital length of stay. After adjusting for GIK solution therapy, OP-CAB surgery resulted in significantly less ischemic injury (troponin I >15 µg/L, 19.0% v 91.3%; p = 0.0001) and reduced postoperative infections (14.3% v 43.5%; p = 0.049). Conclusion: GIK solution therapy achieved NEFA suppression and an insignificant trend toward reduced biochemical parameters of ischemic injury in OP-CAB surgery and CPB groups, but no major clinical benefit (perioperative myocardial infarction, intensive care unit length of stay, or hospital length of stay) was shown after elective CABG surgery in low-risk patients. Compared with CPB, OP-CAB surgery significantly reduced ischemic injury and postoperative infections. Copyright 2002, Elsevier Science (USA). All rights reserved. Publishing and Reprint Information TOP From the Department of Anesthesiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom. Funded in part by a grant from the Royal Brompton and Harefield NHS Trust Fund for research infrastructure development. Address reprint requests to Bernhard J.C.J. Riedel, FCA, MMed, Department of Anesthesiology, Box 042, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4095. E-mail: [email protected] ugust 2002 • Volume 16 • Number 4 Original Articles Intraoperative insulin therapy does not reduce the need for inotropic or antiarrhythmic therapy after cardiopulmonary bypass Leanne Groban, MD [MEDLINE LOOKUP] John Butterworth, MD [MEDLINE LOOKUP] Claudine Legault, PhD [MEDLINE LOOKUP] Anne T. Rogers, MBChB [MEDLINE LOOKUP] Neal D. Kon, MD [MEDLINE LOOKUP] John W. Hammon, MD [MEDLINE LOOKUP] Abstract TOP Objective: To determine whether attempted glucose control through intraoperative insulin therapy reduces the need for inotropic or antiarrhythmic therapy after cardiopulmonary bypass (CPB). Design: Post hoc analysis of a randomized, masked clinical trial of insulin therapy for prevention of neurobehavioral deficits. Setting: Single university hospital. Participants: Nondiabetic patients undergoing elective coronary artery bypass graft surgery (n = 381). Interventions: Patients received either insulin infusions in an attempt to maintain blood glucose at 80 to 120 mg/dL (n = 188) or placebo (saline; n = 193). Inotropic therapy was defined as the initiation of vasoactive support with epinephrine or amrinone infusions or mechanical support with the initiation of an intra-aortic balloon pump in the operating room or within 12 hours postoperatively. Antiarrhythmic therapy was defined as cardioversion, antiarrhythmic medications, or pacing. Measurements and Main Results: Of patients, 64 in the placebo group and 71 in the insulin group required inotropic support after CPB (p = not significant). The use of cardioversion (55 in placebo group v 61 in insulin group), antiarrhythmic medications (64 in placebo group v 76 in insulin group), and pacing (118 in placebo group v 117 in insulin group) was similar between groups. Inotropic drug support was associated with age >60 years, female gender, reduced preoperative ejection fraction, history of angina, and increased duration of CPB. Conclusion: Intraoperative insulin therapy did not reduce the use of inotropic or antiarrhythmic support after cardiac surgery with CPB. The lack of benefit may be due to the inability to prevent hyperglycemia during the physiologic stress of CPB or a tribute to the effectiveness of modern myocardial preservation techniques. Copyright 2002, Elsevier Science (USA). All rights reserved. Publishing and Reprint Information TOP From the Departments of Anesthesiology, Public Health Sciences, and Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC. Funded in part by NS27500-01A2 and by the Departments of Anesthesiology and Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC. Presented in part at the Annual Meeting of the Society of Cardiovascular Anesthesiologists, Inc, Orlando, FL, May 2000.